Prehospital and hospital delays for stroke patients treated with thrombolysis: A retrospective study from mixed rural–urban area in Northern Finland

Varjoranta, Tuure; Raatiniemi, Lasse; Majamaa, Kari; Martikainen, Matti; Liisanantti, Janne

doi:10.1016/j.auec.2019.01.008

Cited by 19 publications

(16 citation statements)

References 25 publications

(26 reference statements)

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“…These findings are in accordance with the principles of our reorganisation. Our reduction of on-scene time also compares favourably with published data from different operational environments in Europe [23][24][25][26][27].…”

Section: Discussionsupporting

confidence: 76%

Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning

2021

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Background: Rapid recanalisation is important when treating ischaemic stroke patients. In Finland, the reorganisation of the prehospital emergency medical system and the establishment of emergency medicine as an independent speciality occurred some years ago. These reforms offered the opportunity to develop new prehospital and in-hospital pathways for stroke patients. Methods: In this retrospective study, we examined the immediate impact of implementing a new operating model in prehospital stroke care. We introduced a modified “load-and-go” model using a transformative learning process. We observed the immediate effects of the reorganisation by comparing prehospital time intervals three months before and three months after the reorganisation. Results: The new operating model was implemented using a transformative learning process. There was an immediate reduction of 35.1% from 21.4 to 13.9 minutes (P < 0.001) in the median on-scene time and of 18.2% from 52.7 to 43.1 minutes (P < 0.05) in the median total time, i.e. the time interval between the alarm from the dispatch centre to patient hand-over to ED. Conclusion: By using a transformative learning process in implementing a modified load-and-go operation model in the EMS, we could immediately reduce median on-scene time and median total time in the treatment of acute stroke patients.

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Section: Discussionsupporting

confidence: 76%

Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning

2021

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“… 26 There are two main reasons reported by nurses have increased their compliance in using PPE in this study: fear to be infected from the patients and PPE has become new standard operating procedures for health care workers in treating patients with COVID-19. 27 …”

Section: Discussionmentioning

confidence: 99%

“We Are at The Forefront of Rural Areas” Emergency Nurse's Experience During Pandemic: A Qualitative Study

Aditya¹,

Yusuf

Razeeni

et al. 2021

Health Equity

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Purpose: The pandemic makes everyone alert, including nurses who are in emergency rooms at community health centers, the importance of their experiences is a lesson for nurses to maintain themselves and be effectivein providing services. This study aimed to explore the experience of nurses who are in emergency rooms at rural area during the coronavirus disease pandemic. Methods: This qualitative research was conducted based on the Nvivo 12 analysis method using in-depth semistructured interviews. Data saturation was reached after 20 interviews were completed. Data collection lasted for 1 month from February to March 2020. Results: Semistructured interviews with 20 nurse participants obtained the following participant characteristics. Eight participants were males and 12 were females with an age ranged from 28 to 43 years (average age 36.4 years). The majority had vocational education (75%), with long experience that ranged from 5 to 15 years (average 11 years). The findings of four themes and seven subthemes. The theme of the findings is Expressions of care, Compliance increases using Personal Protective Equipment (PPE), Focus to refer to, Triage at the forefront. Conclusion: This research reveals that Expressions of care, Compliance increases using PPE, Focus to refer to, Triage at the forefront is the main theme identified in this study. Further investigation of the readiness of nurses in handling patients in the emergency room is considered to be of benefit to the results of this study.

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“…However, Kummer et al analysis of the impact of MSUs in comparison to conventional care in a densely populated urban area with a high number of stroke centres, found that MSU care still resulted in significantly quicker stroke care time metrics [97]. Moreover, AIS patients in rural areas have been shown to experience longer treatment delays [98], due to lack of access to nearby PSCs and CSCs. MSUs could provide a solution to this issue via integration into a rural stroke network.…”

Section: Mobile Stroke Unitsmentioning

confidence: 99%

Optimising Prehospital Pathways to Improve Acute Stroke Reperfusion Therapy Delivery: Systems-Based Approaches

Chowdhury

Wardman

Cordato

et al. 2021

SN Compr. Clin. Med.

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Intravenous thrombolysis and endovascular thrombectomy are the only approved reperfusion treatments available for patients with acute ischemic stroke. Despite the advances in reperfusion therapy, time continues to be a critical factor in the delivery of reperfusion treatment in acute stroke settings. In recent years, some systems-based approaches have been pursued with considerable success. However, approaches aimed at optimising and reducing treatment delays specifically in the prehospital settings are limited. A systems-based approach aimed at improving the process of care in the prehospital setting may result in the reduction of treatment delays and potentially improve clinical outcomes. In this article, we present an overview of the current prehospital acute stroke pathway. Areas to reduce treatment delays are identified and optimisations to the prehospital workflow addressing the identified gaps in acute stroke settings are proposed. Improving process and system gaps would translate to improved post-stroke outcomes following reperfusion therapy.

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Prehospital and hospital delays for stroke patients treated with thrombolysis: A retrospective study from mixed rural–urban area in Northern Finland

Cited by 19 publications

References 25 publications

Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning

Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning

“We Are at The Forefront of Rural Areas” Emergency Nurse's Experience During Pandemic: A Qualitative Study

Optimising Prehospital Pathways to Improve Acute Stroke Reperfusion Therapy Delivery: Systems-Based Approaches

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